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Editor,—We know that Chlamydia trachomatis infections (serovars D-K) are a significant cause of morbidity in the adult population, particularly young women. This justifies the considerable efforts and costs of preventing, diagnosing, and treating chlamydial infections. It is also well established that C trachomatis can cause conjunctivitis and pneumonitis in neonates and infants as a result of vertical transmission.
There is no doubt that symptomatic children should be treated but should we also treat asymptomatic carriers? What would be the benefit of treating asymptomatic children of mothers who were proved or have a history suggestive of C trachomatis infection during their pregnancy? Should we treat these children systematically? Up to what age? These questions have recently arisen in our department after the diagnoses of C trachomatis conjunctivitis in several small children.
The American guidelines for the management of sexually transmitted infection1 do not recommend prophylactic treatment to infants of chlamydia positive mothers but close clinical supervision and treatment if symptoms develop. These guidelines do highlight the importance of antenatal screening as the main preventive measure in the vertical transmission of C trachomatis. Routine prophylaxis with silver nitrate or topical antibiotics would not prevent C trachomatis transmission. Neither the UK national guidelines nor the SIGN (Scottish Intercollegiate Guidelines Network) guidelines2,3 address the issue.
In preadolescent children sexual abuse should always be considered when a diagnosis of C trachomatis has been made, although there are reports of perinatally transmitted infections up to the age of 34 and in our department a family cluster of C trachomatis infection has recently been reported, including a 6 year old girl in whom there was no evidence of sexual abuse.5
We await with interest the results of the pilot chlamydial screening projects in Portsmouth and the Wirral but suggest that routine antenatal screening for C trachomatis infections with a nuclear amplification test (NAT) would reduce perinatal and infant morbidity and possible infection in children, whether symptomatic or not. At the very least, targeted antenatal screening of higher risk groups (young pregnant women up to 25, or those with new or multiple partners, as recommended by the American guidelines) should be clearly specified in the current UK guidelines.
A negative reliable chlamydial test documented during a pregnancy would make a diagnosis of C trachomatis infection in a child less likely to be of vertical perinatal transmission.
In the meantime, what should we do? Investigating and treating asymptomatic children as “contacts” may cause unnecessary anxiety and unpleasantness to both child and parents. Epidemiological antibiotic treatment is not exempt of risks to the individual patient and is likely to increase resistance in the general population.
We would welcome the view of clinicians and thus perhaps open a debate in an area of sexually transmitted infections in which not much is known.
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